DESCRIPTION: Columbia University's Division of Maternal Fetal Medicine has an active and successful clinical research infrastructure. Coupled with this infrastructure is a large obstetrical population. They have made major contributions to multiple multicentered clinical trial groups including the Maternal Fetal Medicine Network. They are now applying along with Christiana Care Health Systems, Inc. for participation in the Nulliparous Network. Ronald Wapner, MD has a superior record of clinical research participation and will be the PI of this application. This center offers not only the clinical attributes required to be a successful participant but also brings the Network exceptional expertise in public health, epidemiology, genetics and epigenetics, placental pathology, and ultrasound. A concept proposal describing the development of an algorhithim to quantify preterm birth risk in nulliparous patients is provided. This study specifically evaluates the impact of the maternal and fetal inflammatory/infectious pathway on preterm birth and investigates the relative role and interactions between genotype, ethnic, cytokine levels, environmental exposures, and demographic factors suggested to increase preterm birth. PUBLIC HEALTH RELEVANCE: Prematurity has long been acknowledged as the most pressing challenge in modern obstetrics, and the rate of preterm birth (PTB) continues to rise resulting in the single largest cause of fetal mortality and long term morbidity. The majority of PTB in the US are to women with no prior birth or previous term births. Thus, from a public health perspective, the overall rate of PTB can only be lowered by targeting risk factors among women delivering their first babv.